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Hepatic storage diseases compromise the integrity of the hepatic parenchyma, with their natural progression leading to liver fibrosis. This article reviews the pathophysiology and radiological characteristics associated with the main aetiologies of hepatic storage diseases, and provides a practical guide on the new diagnostic modalities available for their study.
To evaluate whether routinely assessed MRI features can reliably estimate the timing of rotator cuff tears (RCTs) and to assess the performance of an MRI-based logistic regression model in distinguishing recent from chronic tears. In this retrospective single-center study, 255 patients with clinically and MRI-confirmed RCT following shoulder trauma underwent MRI between 2011 and 2024. Tears were classified as acute (< 6 weeks), subacute (6-12 weeks), or chronic (> 12 weeks) based on the reported date of trauma; acute and subacute tears were grouped as "recent". Ten predefined MRI features were independently assessed. Univariable diagnostic performance metrics were calculated for each feature. A multivariable Firth-penalized logistic regression model was developed to discriminate recent from chronic tears, with internal validation performed using bootstrap resampling. Among the 255 patients (mean age 58.3 years; 65% male), intra-/peri-muscular edema (42% in recent vs 12% in chronic tears) and frayed, hyperintense tendon fibers emerged as independent predictors of recent injury (odds ratios 4.15 and 6.78, respectively). However, traditional markers of chronicity-including fatty infiltration, muscle atrophy, tendon retraction, and superior humeral head migration-showed limited discriminative value. The multivariable model demonstrated modest performance, with an ideal area under the curve (AUC) of 0.74 and an optimism-corrected AUC of 0.68. Sensitivity and specificity at the optimal threshold were 56% and 82%, respectively. Although selected MRI findings are associated with recent RCT, an MRI-based logistic regression model provides limited accuracy for timing estimation.
Atherosclerosis is a chronic disease which can lead to peripheral vascular occlusion causing cardiovascular, cerebrovascular, and peripheral artery diseases (PAD). Key contributors to PAD include ageing, classical cardiovascular risk factors, diabetes mellitus, and hypertension. For decades, these factors have also been related to arterial tortuosity, potentially indicating vascular fragility or arteriopathies. We aimed to evaluate the association between abdominal aortic tortuosity (AAT) and arteriopathies from other vascular beds and to assess its potential role as a subclinical marker of peripheral vascular disease. Atherosclerosis is a chronic disease which can lead to peripheral vascular occlusion causing cardiovascular, cerebrovascular, and peripheral artery diseases (PAD). Key contributors to PAD include ageing, classical cardiovascular risk factors, diabetes mellitus, and hypertension. For decades, these factors have also been related to arterial tortuosity, potentially indicating vascular fragility or arteriopathies. We aimed to evaluate the association between abdominal aortic tortuosity (AAT) and arteriopathies from other vascular beds and to assess its potential role as a subclinical marker of peripheral vascular disease. We included individuals aged ≥ 50 years and excluded those with dorsolumbar scoliosis. We built a multivariate log-linear regression model to identify factors associated with AAT. The model was adjusted by carotid calcification, stiffness, and stenosis as well as individual clinical characteristics and previously registered vascular diseases. A total of 490 individuals (mean age, 66.92 years; range, 50-98 years; 44.29% of women) from the Ageing Imageomics Study were included in this analysis. We observed that the AAT index was strongly dependent on age and also with diastolic blood pressure and estimated glomerular filtration rate (eGFR), but to a lesser extent. In contrast, other classical cardiovascular risk factors like diabetes mellitus, hypertension, smoking, aortic stiffness, and calcification did not play a significant role. Our results do not support the AAT index as a subclinical marker of cardiac, cerebrovascular, or peripheral vascular disease. AAT was not associated with classical cardiovascular risk factors and comorbidities.
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Objective This study aimed to determine the short-term effects of a research methodology course (intervention) on knowledge enhancement of participants from economically emerging (cohort 1) and economically developed (cohort 2) countries; and to determine the long-term publication trajectory of course participants from the time of intervention (timepoint 1 (T1)) to 10 years post-course (timepoint 2 (T2)). Participants/setting Residents/fellows/junior staff from academic institutions of cohorts 1 and 2 completed a four-day research course divided into research design (M1) and statistics (M2) modules. Intervention A 30-item multiple-choice pre-test was provided at the beginning and end of the course for M1 and M2. Pre-/post-test scores assessed knowledge enhancement. A PubMed search (1966-2024) was conducted to evaluate the number, impact factor (IF), and authorship of publications until T1 and T2. Results  In cohort 1, 21 (100%) participants (male-to-female ratio: 11:10; six residents and 15 fellows/junior staff) aspired to an academic career; in cohort 2 (male-to-female ratio: 12:7), 12/19 (63%) (seven residents and five fellows/junior staff) did. At T1, differences were noted between pre- and post-test scores for cohort 1 in M1 (p=0.0005) and M2 (p=0.001), but only for M2 (p=0.01) for cohort 2. For aspiring academicians, whereas the mean number of publications/person was similar between cohort 1 (N=1.1) and cohort 2 (N=2.75) at T1 (p=0.12), it was higher for cohort 2 (N=27.4 vs. N=8.95) at T2 (p=0.03), with similar mean IF of publications for cohorts 1 and 2 at T1 and T2 (p>0.05). Conclusion In the short term, radiology trainees from both countries benefited from the educational research program, particularly in statistics. Over a decade, whereas the quality (IF) of publications remained stable for academicians of both countries, the publication output/person remained stable for cohort 2 participants but declined for cohort 1 participants.
To investigate demographic, morphologic, and morphometric variables associated with early or subclinical imaging-based osteoarthritic structural changes of temporomandibular joint (TMJ). Cone-beam computed tomography scans of 396 TMJs from 198 asymptomatic individuals (75 males, 123 females) were analyzed. TMJs were classified as normal-appearing, indeterminate for osteoarthritis (OA), or affected by OA based on condyle, and fossa/eminence morphology. Univariate and multivariate logistic regression models assessed the association of 5 patient-level and 20 TMJ-level variables with the indeterminate or affected by OA status, adjusting for confounding. Prevalence rates of the indeterminate and affected by OA statuses were 25.80% and 33.30% at the patient-level and 25.30% and 24.50% at the TMJ-level, respectively. Whereas complete/partial edentulism was the only strong/independent indicator for indeterminate for OA category, strong indicators associated with the affected by OA status included age > 38.50 years, complete/partial edentulism, Class II skeletal relationship, horizontal condylar angle ≥ 24.14 degrees, condylar height ≤ 16.00 mm, sagittal glenoid fossa width > 16.95 mm, sagittal articular eminence angle ≤ 45.78 degrees, glenoid fossa roof thickness > 1.23 mm (coronal) and > 1.20 mm (sagittal). CBCT imaging provides a reliable framework for identifying both established and early osteoarthritic changes in the TMJ of asymptomatic adults. Indeterminate cases, often marked by flattening or sclerosis, should be regarded as transitional stages that warrant closer monitoring.
Information about integrated care for patients with atrial fibrillation (AF) in low- and middle-income countries is scarce. We analyzed multicentre data from 699 patients with AF treated in São Paulo, Brazil. ABC compliance was defined as (1) adequate anticoagulation ('A' component); (2) controlled AF symptoms ('B' component); and (3) comorbidities treatment ('C' component). We built logistic regression models to identify characteristics associated with ABC compliance. Mean age was 69.4 ± 14.4 years (45.8% women; 57.4% from private healthcare). Compliance with ABC pathway, and with the 'A,' 'B' and 'C' components occurred in 20.9%, 42.3%, 81.7% and 50.1% of the participants, respectively. Lack of ABC compliance was associated with female sex (adjusted odds ratio [aOR]: 1.66; p = 0.015), intermediate (aOR: 3.37; p < 0.001) and high (aOR: 9.17; p < 0.001) bleeding risk. Patients with AF treated in public units had worse performance for the 'A' component (aOR: 2.50; p < 0.001) and better performance for the 'C' component (aOR: 0.49; p < 0.001) compared to those using private healthcare. Compliance with the ABC pathway in São Paulo, Brazil was low. Lack of ABC compliance was more common in women and individuals with high bleeding risk. We found a mixed pattern of ABC compliance in public and private units.
This cross-sectional study evaluated the 12-lead electrocardiogram (ECG) corrected QT (QTc) interval as an accessible marker for organ-specific iron burden in adult patients with transfusion-dependent thalassemia (TDT). We considered 273 adult TDT patients (37.48 ± 8.75 years; 53.8% females), enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. All patients underwent magnetic resonance imaging (MRI) for the quantification of hepatic, pancreatic, and myocardial iron ( T 2 * $$ {T}_2^{\ast } $$ technique) and the assessment of biventricular size and function, alongside a standard ECG within 3 months. QTc interval showed a significant negative correlation with pancreatic T 2 * $$ {T}_2^{\ast } $$ (R = 0.220; p < 0.0001) and cardiac T 2 * $$ {T}_2^{\ast } $$ (R = -0.201; p = 0.001). A QTc > 425 ms predicted myocardial iron overload (MIO; T 2 * $$ {T}_2^{\ast } $$  < 20 ms). A significant stepwise prolongation of the QTc interval was observed across groups: no iron overload (405.45 ms), isolated pancreatic siderosis (421.76 ms), and combined pancreatic/myocardial siderosis (433.01 ms) (p = 0.001). In patients without MIO, a QTc > 416 ms predicted pancreatic siderosis ( T 2 * $$ {T}_2^{\ast } $$  < 26 ms) and a multivariable regression analysis confirmed pancreatic iron, female sex, and splenectomy as independent predictors of QTc duration. The QTc interval may serve as an early "metabolic sensor" of multi-organ iron toxicity. A QTc > 416 ms is associated with pancreatic siderosis and possible cardiac risk before MRI detects cardiac iron. While QTc alone is unlikely to be sufficient for individual patient risk stratification, this inexpensive and widely available parameter may help inform decisions regarding advanced imaging.
Disc herniation (DH) is a common cause of spinal pain and radiculopathy. While most patients improve with conservative treatment, cases with persistent symptoms may require further intervention. In this context, interventional radiology (IR) offers image-guided, percutaneous techniques as a minimally invasive therapeutic option in the stepwise management of DH. This narrative review, conducted in accordance with SANRA principles, analyses the diagnostic and therapeutic role of IR in cervical, thoracic, and lumbar DH. A structured literature search was performed in PubMed/MEDLINE and Scopus to identify studies evaluating mechanical, thermal, chemical, and regenerative approaches. Reported outcomes included pain relief, functional recovery, complication rates, and need for reintervention. Evidence suggests that percutaneous intradiscal procedures may achieve meaningful short- and medium-term clinical improvement in carefully selected patients with contained herniations and clinicoradiological concordance. These techniques are associated with reduced invasiveness, shorter recovery times, and lower complication rates when performed by experienced practitioners. Imaging plays a central role in diagnosis, patient selection, procedural planning, as well as technical accuracy and safety. Nonetheless, current evidence remains heterogeneous and largely based on observational studies, with limited long-term comparative data. Further multicentre prospective trials and standardized outcome reporting are required to better define indications and lasting effectiveness.
To describe the development, training and evaluation of AI WaveMar, an artificial intelligence (AI)-based tool designed for the automated detection of suspicious mammographic findings in breast cancer screening. An image classification model based on convolutional neural networks has been developed. The model has been trained on a mixed dataset of 48,562 anonymised mammographic projections, obtained from a public hospital in Spain and the external Chinese Mammography Database (CMMD). The model was evaluated on an independent test set composed of 4902 images. Performance metrics calculated included sensitivity (S or recall), specificity (SP), positive predictive value (PPV or precision), negative predictive value (NPV), accuracy and F1-score. AI WaveMar achieved a sensitivity of 92.95% (P < .001) and a specificity of 98.12% (P < .001). The PPV was 89.79% (P < .001), and the NPV was 98.74% (P < .001). Accuracy reached 97,34% (P < .001), with an F1-score of 92.34%, indicating high and balanced diagnostic performance. AI WaveMar is an AI-based tool developed to support mammographic interpretation, with preliminary results suggesting it could help optimise breast cancer screening. However, prospective clinical validation in real-world practice is required to confirm its diagnostic utility.
To characterize the clinical presentation, endocrine phenotype, and outcomes of pituitary metastasis in a contemporary tertiary-center cohort, with emphasis on clinically actionable diagnostic red flags. We conducted a retrospective single-center case series of 14 consecutive patients diagnosed with pituitary metastasis between 2010 and 2025. Presenting manifestations, endocrine features, radiologic findings, primary tumor origin, treatment patterns, and overall survival were assessed. In patients without histopathologic confirmation, diagnosis was established using the validated clinicoradiologic model proposed by Yuzkan et al. RESULTS: Median age was 52.5 years, and 71.4% of patients were women. Hypopituitarism (64.3%), arginine vasopressin deficiency (50.0%), and visual impairment (50.0%) were frequent at presentation. One patient presented with sudden bilateral visual loss and hemodynamic instability, mimicking an apoplexy-like sellar emergency. Breast cancer was the most common primary tumor (28.6%). Serum prolactin levels, available in 11 patients, were uniformly below the range typically expected for macroprolactinoma despite large sellar masses. Histopathologic confirmation was obtained in 35.7% of cases, whereas the remainder fulfilled high-likelihood clinicoradiologic criteria. Median overall survival after pituitary metastasis diagnosis was 6.5 months, and 92.9% of patients died during follow-up. Pituitary metastasis frequently presents with combined endocrine dysfunction and neuro-ophthalmologic compromise, occasionally as an acute sellar emergency. In oncologic patients with sellar lesions, the combination of AVP-D, visual deterioration, and non-prolactinoma-range hyperprolactinemia should raise suspicion for pituitary metastasis and prompt urgent endocrine and local evaluation.
We assessed the effect of hepatic iron levels on liver apparent diffusion coefficient (ADC) values assessed by magnetic resonance imaging (MRI) and the influence of different b-values on the extent of this association. We prospectively enrolled 110 patients (60 women, 33.05 ± 7.86 years) with beta-thalassemia. Single-shot echoplanar diffusion-weighted imaging (DWI) with different b values was acquired, and ADC_200 (b-values 0/200 s/mm2), ADC_600 (b-values 0/600 s/mm2), and ADC_1000 (b-values 0/1000 s/mm2) were obtained. Liver T2* values were measured with a gradient-echo multiecho sequence and were converted into liver iron concentration (LIC) values. There was a significant difference among the three different ADC values (p < 0.0001). Mean MRI LIC values were 7.99 ± 10.09 mg/g dw, and 64 (58.2%) patients had liver iron overload (LIC > 3 mg/g dw). Significant negative correlation was found between MRI LIC values and ADC_200 values (R = -0.284, p = 0.003), ADC_600 values (R = -0.645, p < 0.00001), and ADC_1000 values (R = -0.842, p < 0.0001). MRI LIC was more strongly correlated with both ADC_600 and ADC_1000 than with ADC_200 (p < 0.00001 for both comparisons) and with ADC_600 than with ADC_200 (p < 0.0001). ADC_200 values were comparable between patients without and with liver iron overload (2.11 ± 0.53 vs. 1.87 ± 0.89 × 10-3 mm2/s, p = 0.081), while patients with liver iron overload had significantly decreased ADC_600 values (0.91 ± 0.72 vs. 1.52 ± 0.49 × 10-3 mm2/s, p < 0.0001), and ADC_1000 values (0.48 ± 0.38 vs. 1.23 ± 0.23 × 10-3 mm2/s, p < 0.0001). In conclusion, the demonstrated inverse correlation between LIC and liver ADC values, accentuated at higher diffusion b-values, has relevant clinical implications, indicating that liver iron overload acts as a confounding factor in quantitative DWI and should be accounted for to avoid misinterpretation of liver ADC measurements in diagnostic and therapeutic workflows.
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Pelvic exenteration is a highly complex and aggressive surgical procedure that seeks to cure patients with pelvic tumours through the en bloc removal of two or more organs. Given its technical complexity and high rates of morbidity and mortality, careful selection of surgical candidates is essential, prioritising those for whom complete tumour resection is feasible. The preoperative management of these patients requires a multidisciplinary approach, with the radiologist playing a critical role. It is imperative for the radiologist to be familiar with the anatomical and pathological aspects to be assessed using different imaging techniques (CT, MRI, or PET-CT). Key considerations include the detection of extrapelvic metastatic disease, involvement of pelvic organs, neural structures, vessels, and the pelvic wall (muscular and bony components). The aim of this update is to familiarise the radiologist with pelvic exenteration, as a thorough evaluation can provide necessary information to guide the surgical team, minimise complications and avoid unnecessary interventions.
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Incident Learning Systems (ILSs) are central to patient safety in radiotherapy, enabling learning from adverse events and near misses. Despite EU regulatory requirements, substantial variability persists across Europe in the implementation and effectiveness of ILSs in radiotherapy. This paper presents radiotherapy-specific recommendations derived from the MARLIN study to support harmonised, risk-informed implementation of ILSs. The 24-month MARLIN study, conducted under the SAMIRA Action Plan, employed a structured literature review, an online European survey of clinical facilities, competent authorities and professional societies, expert interviews, and a multi-stakeholder consensus workshop. Survey data from 172 respondents in 28 countries were analysed to identify current practices, barriers and enabling factors for ILS implementation in radiotherapy. Although all responding countries reported transposition of the Directive, substantial variability was observed in criteria for reporting significant radiotherapy events, feedback mechanisms and use of international databases. Fear of punitive actions, limited resources, lack of training in incident analysis, and insufficient dissemination of lessons learned were identified as key barriers. External-beam radiotherapy showed more mature ILS implementation than brachytherapy. Findings from the MARLIN study informed recommendations on category-based event classification, radiotherapy-specific taxonomies, multidisciplinary incident-learning committees, and collaboration between clinical facilities, competent authorities and professional societies. The MARLIN recommendations provide a practical framework to strengthen ILS implementation in radiotherapy, promote a just culture, enhance learning from incidents and support regulatory compliance, ultimately improving patient safety and quality of care across Europe, while the broader RP-208 report extends these principles to all medical fields using ionising radiation, supporting cross-disciplinary harmonisation.
Here, we present the case of a 25-year-old patient with G542X and G85E cystic fibrosis mutations who underwent computed tomography examination before and after triple-combination therapy. Clear improvement in sinonasal and lung involvement is visible two years after modulator treatment initiation. To the best of our knowledge, this is the first report about sinonasal improvement demonstrated by computed tomography images in a patient with G542X/G85E mutations.
In the early time window, direct mechanical thrombectomy (MT) is not non-inferior to combined treatment with intravenous thrombolysis (IVT) for patients with large vessel occlusion (LVO) stroke, while its non-inferiority in the extended time window remains uncertain. This study assessed whether direct MT is non-inferior to IVT + MT beyond 4.5 h or at wake-up. We emulated a non-inferiority trial, comparing direct MT vs. IVT + MT, including patients with anterior circulation LVO between 4.5 and 24 h from symptom onset or at wake-up, without contraindications to IVT and with target perfusion mismatch. We used inverse probability weighting (IPW) adjusted for pre-specified covariates. The primary outcome was 90-day mRS 0-2, with non-inferiority defined by a lower 95% CI boundary of the Risk Difference (RD) ≥ -1.3%. Among 347 patients, 212 received direct MT and 135 received IVT + MT. After IPW, patients treated with direct MT and IVT + MT had a similar likelihood of achieving a 90-day mRS of 0-2 (adjRD -2.90 [95% CI -6.64 to 0.84]) with the lower boundary of the RD 95% CI crossing the non-inferiority margin. Additionally, direct MT was associated with a shift toward a higher score on the 90-day mRS (adjusted Common OR 1.59 [95% CI 1.05-2.39]), not confirmed after IPW, and with lower odds of successful recanalization (adjOR 0.38 [95% CI 0.18-0.78]). Rates of 90-day mRS 0-1, sICH, and mortality were similar between groups. In our target trial emulation, direct MT was not non-inferior to IVT + MT treatment beyond 4.5 h from symptom onset or at wake-up, with IVT before MT yielding higher successful recanalization rates.
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This review aims to provide a comprehensive overview of the current evidence on the use of MRI-guided SBRT for oligometastases in gynaecological cancers and its potential benefits. Following PRISMA guidelines, we conducted a systematic review to identify studies focusing on MRI-guided SBRT for oligometastatic gynaecological cancer. Inclusion criteria specified English-language studies that reported clinical outcomes and toxicity data. Data extraction included study design, tumour characteristics, type of MRI-Linac utilized, treatment protocols, clinical outcomes, and toxicity profiles. Of the 475 identified articles, three studies met the inclusion criteria, encompassing 45 patients with oligometastatic gynaecological cancers, predominantly ovarian, treated with 0.35-1.5 T MRI-Linac SBRT. Doses ranged from 30 to 50 Gy over five fractions. Focusing on actuarial outcome, all the patients were alive and maintained local control at 3 months from SBRT. The toxicity profile was available in all the studies, reporting only one Grade 3 event (gastro-intestinal), underscoring a favourable safety profile. Despite some technical challenges, such as extended treatment times and limited MRI-Linac availability, MRI-guided SBRT appears to be a promising modality for oligometastatic ovarian cancer, potentially delaying the need for systemic therapy and chemotherapy line change. Larger studies are required to validate these findings and better establish the advantages relative to the use of this innovative approach.